[Congressional Record Volume 149, Number 163 (Tuesday, November 11, 2003)]
[Senate]
[Pages S14453-S14454]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. SNOWE:
  S. 1846. A bill to amend title 38, United States Code, to establish a 
presumption of service-connection for certain veterans with hepatitis 
C, and for the other purposes; to the Committee on Veterans' Affairs.
  Ms. SNOWE. Mr. President, I rise today to reintroduce legislation I 
first introduced in the 105th Congress to address a serious health 
concern for veterans--specifically, the health threat posed by the 
Hepatitis C virus.
  This legislation, the Veterans Hepatitis C Treatment bill, 
establishes a presumption of service connection for veterans with 
hepatitis C, provided that certain conditions are met. This bill will 
enable veterans who contracted Hepatitis C in military service to 
receive treatment for this condition by the Department of Veterans 
Affairs.
  Under this legislation, veterans who received a transfusion of blood 
during a period of service before December 31, 1992; veterans who were 
exposed to blood during a period of service; veterans who underwent 
hemodialysis during a period of service; veterans diagnosed with 
unexplained liver disease during a period of service; or veterans 
working in a health care occupation during service, will be eligible 
for treatment for Hepatitis C at VA facilities.
  I have reviewed medical research that suggests many veterans were 
exposed to Hepatitis C in service, and are now suffering from liver 
disease and other diseases caused by exposure to this virus. I am 
troubled that many ``Hepatitis C veterans'' are not being treated by 
the VA because they can't prove the virus was service connected, 
despite the fact that Hepatitis was not isolated until 1989 and could 
not be tested for until 1990.
  Hepatitis C is a hidden infection with few symptoms. However, most of 
those infected with the virus will develop serious liver disease 10 to 
30 years after contracting the virus. For many of those infected, 
Hepatitis C can lead to liver failure, transplants, liver cancer and 
death.
  And yet, most people who have Hepatitis C don't even know it--and so 
they don't get treatment until it's too late. It has been estimated 
that up to 70 percent of the approximately four million Americans with 
Hepatitis C are unaware that they carry the virus. For those who know 
they're infected, the

[[Page S14454]]

prognosis is promising--some estimates indicate that 50 percent may 
have the virus eradicated.
  Vietnam veterans in particular are just now starting to learn that 
they have liver disease likely caused by Hepatitis C. Early detection 
and treatment may help head off serious liver disease for many of them. 
However, many veterans with Hepatitis C will not be treated by the VA 
because they must first establish a service connection for their 
condition--a standard that is virtually impossible to meet.
  My colleagues may be interested to know how veterans were likely 
exposed to this virus. Medical advances during the Vietnam War included 
rapid evacuation, improved transfusion and high rates of U.S. casualty 
survival in an era prior to Hepatitis C screening of the blood supply. 
Blood transfusion is one of the most common ways Hepatitis C is 
transmitted. Medical transmission of the virus through needles and 
other medical equipment is also possible in combat. Medical care 
providers who served in combat, where universal precautions and rubber 
glove use are often absent, were likely at increased risk as well, and 
may have, in turn, posed a risk to the service members they treated.
  Researchers have discovered that some blood sent from the U.S. was 
infected with the virus. Researchers and veterans organizations, 
including the Vietnam Veterans of America, believe that many veterans 
were infected after being injured in combat and getting a transfusion 
or from working as a medic around combat injuries.
  Yet, veterans cannot establish a service connection because 
frequently there were no symptoms when they were originally infected 
while in Vietnam. In addition, while medical records may show a short 
bout of Hepatitis, Hepatitis C was not known at the time and there was 
not a test available to detect the virus.
  The Hepatitis C infected veteran is essentially in a catch-22 
situation: the VA will not provide treatment unless a service 
connection has been established, but the veterans cannot prove that 
they contracted Hepatitis C in combat because the science to detect the 
virus didn't exist. Without legislative authority to treat these 
veterans, thousands of veterans infected with Hepatitis C while in the 
service will not receive VA health care testing or treatment.
  I believe that in the long run we will actually save money by testing 
and treating this infection early on. The alternative is much more 
costly treatment of end-state liver disease and the associated 
complications, or other disorders.
  Former Surgeon General C. Everett Koop, well respected both within 
and outside of the medical profession, has said: ``In some studies of 
veterans entering the Department of Veterans Affairs health facilities, 
half of the veterans have tested positive for [the Hepatitis C virus]. 
Some of those veterans may have left the military with the [Hepatitis C 
virus], while others may have developed it after their military 
service. In any event, we need to detect and treat [Hepatitis C] if we 
are to head off very high rates of liver disease and liver transplant 
in VA facilities over the next decade.''
  Some may argue that further epidemiologic data is needed to resolve 
the issue of service connection. I agree that we have our work cut out 
for us, and further study should be done. However, there is already a 
substantial body of research which has firmly established that veterans 
have a higher incidence of Hepatitis C when compared to non-veterans. 
We should not ask those who have already sacrificed so much for this 
country to wait--perhaps for years--for the treatment they deserve 
while further research is being conducted.
  Today is Veteran's Day and we will all take time to honor the 
sacrifices that these brave men and women have made to defend the 
freedom of this country and ensure others could live in peace. These 
veterans shouldn't be asked to fight another battle for the benefits 
and respect that they have earned.
  I hope this legislation will be a constructive step in addressing the 
health concerns of this Nation's veterans, and I look forward to 
working with the Veterans Affairs Committee, the VA-HUD appropriators, 
and veterans groups to meet this emerging challenge.
                                 ______